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We all want to stay home. How can Medicare help? Does Medicare pay for Home Health Care?

How to qualify for Home Health Care

Medicare covers “necessary and reasonable” intermittent, not full time, care by a home health agency with no time limit if certain criteria are met, including a need for part-time or intermittent nursing or therapy. Many people do not meet this requirement and so cannot receive Medicare covered home health: without nursing or therapy, it is considered custodial care, which Medicare does not cover.

A doctor must certify (or re-certify) a plan of care for home health agency services to be covered. The doctor’s orders must state the type of services to be provided, the frequency and who should provide them. The plan of care may include nursing for up to eight hours per day for up to 21 days (with re-certification possible) but nursing and home health care combined is covered for a total of 28-35 hours per week.

Some people mistakenly think that this can only be provided while there is improvement. In fact, skilled nursing includes care to maintain a person’s condition or slow their decline. The same is true of physical therapy, occupational therapy and speech and language therapy. That can be very important for people with ALS, MS, Parkinson’s or Alzheimer’s and for people who are paralyzed following an accident or a stroke. In addition, medical social services can be provided to resolve social or emotional impediments to effective therapy.

Does Medicare cover Medical Supplies?

Medical supplies essential for home health agency personnel are provided. Durable medical equipment subject to a 20% co-pay.

What services are provided by home health aides?

The purpose of home health aide visits must be to provide hands-on personal care or services needed to help maintain health or facilitate treatment. These services could include bathing, dressing, grooming, hair and nail care and oral hygiene if needed to facilitate treatment or prevent deteriorating health. They may include shaving, applying deodorant, skin lotion and powder, foot and ear care. They may include routine catheter and colostomy care, enemas and changing the bed linens of someone who is incontinent. They may include help changing position in bed, walking and moving from one place to another.

A home health aide may also help with simple dressing changes and administering medicines as long as neither of these require the assistance of a licensed nurse. Help may be given with routine maintenance exercise and repetitive practice of functional communication skills in support of therapy and with care of prosthetic and orthotic devices.

Incidental services such as laundry and making a light meal may also be provided.

All of these services must be “reasonable and necessary.” In addition to being part of a doctor- ordered plan of care, this means that they must be help with things which the person cannot do for herself and for which she has no able or willing caregiver.

 

 

Estate Planning attorney, Terry Garrett, is a member of the National Academy of Elder Law Attorneys and is active in the Texas and Austin Bar Associations. She graduated with honors from Cornell University. She was on the Dean’s List at Wharton Business School. She earned her J.D. at Columbia Law School, receiving the Parker Award and a Mellon Fellowship.

She assists families of people with special needs, people planning for the retirement years and people administering estates.

 

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